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Wang Q, Dong J, Du M, Liu X, Zhang S, Zhang D, Qin W, Xu X, Li X, Su R, Qiu L, Li B, Yuan H. Chitosan-Rapamycin Carbon Dots Alleviate Glaucomatous Retinal Injury by Inducing Autophagy to Promote M2 Microglial Polarization. Int J Nanomedicine 2024; 19:2265-2284. [PMID: 38476273 PMCID: PMC10928492 DOI: 10.2147/ijn.s440025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Glaucoma is a prevalent cause of irreversible vision impairment, characterized by progressive retinal ganglion cells (RGCs) loss, with no currently available effective treatment. Rapamycin (RAPA), an autophagy inducer, has been reported to treat glaucoma in rodent models by promoting RGC survival, but its limited water solubility, systemic toxicity, and pre-treatment requirements hinder its potential clinical applications. Methods Chitosan (CS)-RAPA carbon dot (CRCD) was synthesized via hydrothermal carbonization of CS and RAPA and characterized by transmission electron microscopy, Fourier transform infrared spectra, and proton nuclear magnetic resonance. In vitro assays on human umbilical cord vein endothelial and rat retinal cell line examined its biocompatibility and anti-oxidative capabilities, while lipopolysaccharide-stimulated murine microglia (BV2) assays measured its effects on microglial polarization. In vivo, using a mouse retinal ischemia/reperfusion (I/R) model by acute intraocular pressure elevation, the effects of CRCD on visual function, RGC apoptosis, oxidative stress, and M2 microglial polarization were examined. Results CRCD exhibited good water solubility and anti-oxidative capabilities, in the form of free radical scavenging. In vitro, CRCD was bio-compatible and lowered oxidative stress, which was also found in vivo in the retinal I/R model. Additionally, both in vitro with lipopolysaccharide-stimulated BV2 cells and in vivo with the I/R model, CRCD was able to promote M2 microglial polarization by activating autophagy, which, in turn, down-regulated pro-inflammatory cytokines, such as IL-1β and TNF-α, as well as up-regulated anti-inflammatory cytokines, such as IL-4 and TGF-β. All these anti-oxidative and anti-inflammatory effects ultimately aided in preserving RGCs, and subsequently, improved visual function. Discussion CRCD could serve as a potential novel treatment strategy for glaucoma, via incorporating RAPA into CDs, in turn not only mitigating its toxic side effects but also enhancing its therapeutic efficacy.
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Affiliation(s)
- Qi Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, People’s Republic of China
- Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Jiaxin Dong
- Institute for Advanced Ceramics, State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin, People’s Republic of China
| | - Mengxian Du
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xinna Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, People’s Republic of China
- Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Shiqi Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Di Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Wanyun Qin
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Xikun Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, People’s Republic of China
| | - Xianghui Li
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
| | - Ruidong Su
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, People’s Republic of China
| | - Leyi Qiu
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry Education, Harbin, People’s Republic of China
| | - Baoqiang Li
- Institute for Advanced Ceramics, State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin, People’s Republic of China
- Laboratory of Dynamics and Extreme Characteristics of Promising Nanostructured Materials, Saint Petersburg State University, St. Petersburg, Russia
| | - Huiping Yuan
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China
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Daich Varela M, Dixit M, Kalitzeos A, Michaelides M. Adaptive Optics Retinal Imaging in RDH12-Associated Early Onset Severe Retinal Dystrophy. Invest Ophthalmol Vis Sci 2024; 65:9. [PMID: 38466282 PMCID: PMC10929749 DOI: 10.1167/iovs.65.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/03/2023] [Indexed: 03/12/2024] Open
Abstract
Purpose RDH12 is among the most common genes found in individuals with early-onset severe retinal (EOSRD). Adaptive optics scanning light ophthalmoscopy (AOSLO) enables resolution of individual rod and cone photoreceptors in the retina. This study presents the first AOSLO imaging of individuals with RDH12-associated EOSRD. Methods Case series of patients who attended Moorfields Eye Hospital (London, UK). Spectral-domain optical coherence tomography, near-infrared reflectance (NIR), and blue autofluorescence imaging were analyzed. En face image sequences of photoreceptors were recorded using either of two AOSLO modalities. Cross-sectional analysis was undertaken for seven patients and longitudinal analysis for one patient. Results Nine eyes from eight patients are presented in this case series. The mean age at the time of the assessment was 11.2 ± 6.5 years of age (range 7-29). A subfoveal continuous ellipsoid zone (EZ) line was present in eight eyes. Posterior pole AOSLO revealed patches of cone mosaics. Average cone densities at regions of interest 0.5° to the fovea ranged from 12,620 to 23,660 cells/mm2, whereas intercell spacing ranged from 7.0 to 9.7 µm. Conclusions This study demonstrates that AOSLO can provide useful high-quality images in patients with EOSRD, even during childhood, with nystagmus, and early macular atrophy. Cones at the posterior pole can appear as scattered islands or, possibly later in life, as a single subfoveal conglomerate. Detailed image analysis suggests that retinal pigment epithelial stress and dysfunction may be the initial step toward degeneration, with NIR being a useful tool to assess retinal well-being in RDH12-associated EOSRD.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Mira Dixit
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Angelos Kalitzeos
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
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3
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Feng KM, Tsung TH, Chen YH, Lu DW. The Role of Retinal Ganglion Cell Structure and Function in Glaucoma. Cells 2023; 12:2797. [PMID: 38132117 PMCID: PMC10741833 DOI: 10.3390/cells12242797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Glaucoma, a leading cause of irreversible blindness globally, primarily affects retinal ganglion cells (RGCs). This review dives into the anatomy of RGC subtypes, covering the different underlying theoretical mechanisms that lead to RGC susceptibility in glaucoma, including mechanical, vascular, excitotoxicity, and neurotrophic factor deficiency, as well as oxidative stress and inflammation. Furthermore, we examined numerous imaging methods and functional assessments to gain insight into RGC health. Finally, we investigated the current possible neuroprotective targets for RGCs that could help with future glaucoma research and management.
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Affiliation(s)
| | | | | | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.M.F.); (T.-H.T.); (Y.-H.C.)
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Schmetterer L, Scholl H, Garhöfer G, Janeschitz-Kriegl L, Corvi F, Sadda SR, Medeiros FA. Endpoints for clinical trials in ophthalmology. Prog Retin Eye Res 2023; 97:101160. [PMID: 36599784 DOI: 10.1016/j.preteyeres.2022.101160] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
With the identification of novel targets, the number of interventional clinical trials in ophthalmology has increased. Visual acuity has for a long time been considered the gold standard endpoint for clinical trials, but in the recent years it became evident that other endpoints are required for many indications including geographic atrophy and inherited retinal disease. In glaucoma the currently available drugs were approved based on their IOP lowering capacity. Some recent findings do, however, indicate that at the same level of IOP reduction, not all drugs have the same effect on visual field progression. For neuroprotection trials in glaucoma, novel surrogate endpoints are required, which may either include functional or structural parameters or a combination of both. A number of potential surrogate endpoints for ophthalmology clinical trials have been identified, but their validation is complicated and requires solid scientific evidence. In this article we summarize candidates for clinical endpoints in ophthalmology with a focus on retinal disease and glaucoma. Functional and structural biomarkers, as well as quality of life measures are discussed, and their potential to serve as endpoints in pivotal trials is critically evaluated.
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Affiliation(s)
- Leopold Schmetterer
- Singapore Eye Research Institute, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; Academic Clinical Program, Duke-NUS Medical School, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
| | - Hendrik Scholl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Lucas Janeschitz-Kriegl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
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5
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Chauhan BC. Understanding the Increasing Role of Optical Coherence Tomography in Glaucoma Diagnostics and Disease Progression. JAMA Ophthalmol 2023; 141:890. [PMID: 37589988 DOI: 10.1001/jamaophthalmol.2023.3732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Grannonico M, Miller DA, Gao J, McHaney KM, Liu M, Krause MA, Netland PA, Zhang HF, Liu X. Longitudinal Analysis of Retinal Ganglion Cell Damage at Individual Axon Bundle Level in Mice Using Visible-Light Optical Coherence Tomography Fibergraphy. Transl Vis Sci Technol 2023; 12:10. [PMID: 37163286 PMCID: PMC10179604 DOI: 10.1167/tvst.12.5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/09/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose We developed a new analytic tool based on visible-light optical coherence tomography fibergraphy (vis-OCTF) to longitudinally track individual axon bundle transformation as a new in vivo biomarker for retinal ganglion cell (RGC) damage. Methods After acute optic nerve crush injury (ONC) in mice, we analyzed four parameters: lateral bundle width, axial bundle height, cross-sectional area, and the shape of individual bundles. We next correlated the morphological changes in RGC axon bundles with RGC soma loss. Results We showed that axon bundles became wider and taller at three days post ONC (pONC), which correlated with about 15% RGC soma loss. At six days pONC, axon bundles showed a significant reduction in lateral width and cross-sectional area, followed by a reduction in bundle height at nine days pONC. Bundle shrinking at nine days pONC correlated with about 68% RGC soma loss. Both experimental and simulated results suggested that the cross-sectional area of individual RGC axon bundles is more sensitive than bundle width and height to indicate RGC soma loss. Conclusions This study is the first to track and quantify individual RGC axon bundles in vivo after ONC injury. Translational Relevance Recognizing RGC loss at its earliest stage is crucial for disease diagnosis and treatment. However, current clinical methods to detect the functional and structural changes in the inner retina are not sensitive enough to directly assess RGC health. In this study, we developed vis-OCTF-based parameters to track RGC damage, making possible to establishing a quantifiable biomarker for glaucoma.
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Affiliation(s)
- Marta Grannonico
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - David A. Miller
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Jingyi Gao
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Kara M. McHaney
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Mingna Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Michael A. Krause
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Peter A. Netland
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Hao F. Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Xiaorong Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
- Program in Fundamental Neuroscience, University of Virginia, Charlottesville, VA, USA
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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7
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Cheung R, Ho S, Ly A. Optometrists' attitudes toward using OCT angiography lag behind other retinal imaging types. Ophthalmic Physiol Opt 2023. [PMID: 37082888 DOI: 10.1111/opo.13149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/14/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE While optometrists' attitudes toward established retinal imaging types are generally positive, they are unknown for optical coherence tomography angiography (OCTA). We performed a cross-sectional survey to estimate attitudes toward OCTA and identify clinician and/or practice characteristics that influence them. METHODS A paper-based survey was mailed to 252 randomly selected optometrists in Australia. Five-point Likert-scale items from a previous survey assessing attitudes toward new technology were included to probe respondent characteristics and attitudes toward retinal imaging. Performance expectancy attitudes toward OCTA were elicited by the statement 'I believe OCTA is useful in daily practice'. Mean scores out of five (mean [SD]) were rounded and mapped to appropriate descriptive statements. RESULTS The response rate was 47% (118/252). The mean (SD) age of respondents was 44.0 (13.8) years and 50.8% (60/118) were female. Optometrists had 19.9 (14.0) years of clinical experience and 66.9% (79/118) worked at independent practices. In total, 8.5% (10/118) of respondents used OCTA to provide clinical care. Optometrists agreed that optical coherence tomography (OCT), colour fundus imaging, ultra-wide field imaging and fundus autofluorescence (mean scores 3.6-4.7 out of 5) were useful in daily practice but felt neutral about whether OCTA was useful (3.4 [0.8]). Optometrists believed that OCTA was less enjoyable to use (p < 0.0001), less endorsed by peers (p < 0.0001) and felt less confident that they had the knowledge to interpret OCTA (p < 0.0001) compared to other retinal imaging types. CONCLUSIONS Optometrists are undecided on whether OCTA is useful in daily practice and had lower expectations that using OCTA would confer job performance benefits compared to other retinal imaging types. Further work is needed to advocate the benefits of using OCTA across the profession.
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Affiliation(s)
- Rene Cheung
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharon Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Angelica Ly
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
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8
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Kotcharlakota D, Choudhari NS. Role Of Adaptive Optics In Early Diagnosis Of Glaucoma From A Clinician's Perspective. Semin Ophthalmol 2023; 38:44-51. [PMID: 35989652 DOI: 10.1080/08820538.2022.2112701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Glaucoma is one of the leading causes of irreversible blindness across the world. Early detection is important to minimize the loss of visual function. The diagnostic tools, optical coherence tomography (OCT) and standard automated perimetry (SAP) form the keystones of the diagnosis and monitoring of the condition. However, the ability of these tools to diagnose early forms of glaucoma is limited. Adaptive optics (AO) is a technology that could help to overcome this limitation. AO technology can detect slightest changes occurring at the cellular level by compensating for ocular aberrations. METHODS We searched PubMed for publications between 2002 and 2019 on adaptive optics in Ophthalmology. The key words were adaptive optics, lamina cribrosa, retinal nerve fiber layer defects, scanning laser ophthalmoscope and OCT. RESULTS Out of 38 publications, 17 original articles or case series with relevance to glaucoma, and written in English were selected and reviewed. CONCLUSIONS The AO technology, combined with various platforms such as fundus photography, scanning laser ophthalmoscopy and OCT, has been used in glaucoma patients to study the lamina cribrosa, retinal nerve fiber layer (RNFL), retinal photoreceptors as well as ocular circulation in minute detail. Imaging the subtle changes in morphology and reflectivity of RNFL at the preclinical stage may lead to early detection of glaucoma. Longitudinal monitoring of RNFL alterations in glaucoma patients is possible. At present, the technology is expensive with limited availability, and has several limitations.
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Affiliation(s)
- Divya Kotcharlakota
- Glaucoma Fellow, VST Centre for Glaucoma Care, Dr. Kallam Anji Reddy campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Nikhil S Choudhari
- Faculty, VST Centre for Glaucoma Care, Dr. Kallam Anji Reddy campus, L. V. Prasad Eye Institute, Hyderabad, India
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9
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Morgan JIW, Chui TYP, Grieve K. Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:387-428. [PMID: 36698659 PMCID: PMC9841996 DOI: 10.1364/boe.472274] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 05/02/2023]
Abstract
Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Contributed equally
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
- Contributed equally
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
- Contributed equally
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10
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Impact of Penetration and Image Analysis in Optical Coherence Tomography on the Measurement of Choroidal Vascularity Parameters. Retina 2022; 42:1965-1974. [DOI: 10.1097/iae.0000000000003547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Leung CKS, Lam AKN, Weinreb RN, Garway-Heath DF, Yu M, Guo PY, Chiu VSM, Wan KHN, Wong M, Wu KZ, Cheung CYL, Lin C, Chan CKM, Chan NCY, Kam KW, Lai GWK. Diagnostic assessment of glaucoma and non-glaucomatous optic neuropathies via optical texture analysis of the retinal nerve fibre layer. Nat Biomed Eng 2022; 6:593-604. [PMID: 34992272 DOI: 10.1038/s41551-021-00813-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/17/2021] [Indexed: 01/14/2023]
Abstract
The clinical diagnostic evaluation of optic neuropathies relies on the analysis of the thickness of the retinal nerve fibre layer (RNFL) by optical coherence tomography (OCT). However, false positives and false negatives in the detection of RNFL abnormalities are common. Here we show that an algorithm integrating measurements of RNFL thickness and reflectance from standard wide-field OCT scans can be used to uncover the trajectories and optical texture of individual axonal fibre bundles in the retina and to discern distinctive patterns of loss of axonal fibre bundles in glaucoma, compressive optic neuropathy, optic neuritis and non-arteritic anterior ischaemic optic neuropathy. Such optical texture analysis can detect focal RNFL defects in early optic neuropathy, as well as residual axonal fibre bundles in end-stage optic neuropathy that were indiscernible by conventional OCT analysis and by red-free RNFL photography. In a diagnostic-performance study, optical texture analysis of the RNFL outperformed conventional OCT in the detection of glaucoma, as defined by visual-field testing or red-free photography. Our findings show that optical texture analysis of the RNFL for the detection of optic neuropathies is highly sensitive and specific.
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Affiliation(s)
- Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong. .,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong. .,Queen Mary Hospital, Pok Fu Lam, Hong Kong. .,Hong Kong Eye Hospital, Kowloon City, Hong Kong.
| | - Alexander Ka Ngai Lam
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert Neal Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, CA, USA
| | - David F Garway-Heath
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Marco Yu
- Singapore Eye Research Institute, Singapore, Singapore
| | - Philip Yawen Guo
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Vivian Sheung Man Chiu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kelvin Ho Nam Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Eye Hospital, Kowloon City, Hong Kong.,Department of Ophthalmology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Mandy Wong
- Hong Kong Eye Hospital, Kowloon City, Hong Kong
| | - Ken Zhongheng Wu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Carol Yim Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chen Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carmen Kar Mun Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Eye Hospital, Kowloon City, Hong Kong
| | - Noel Ching Yan Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Ophthalmology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Gilda Wing Ki Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Abstract
PURPOSE OF REVIEW To summarize the literature on three-dimensional (3D) technological advances in ophthalmology, the quantitative methods associated with this, and their improved ability to help detect glaucoma disease progression. RECENT FINDINGS Improvements in measuring glaucomatous structural changes are the result of dual innovations in optical coherence tomography (OCT) imaging technology and in associated quantitative software. SUMMARY Compared with two-dimensional (2D) OCT parameters, newer 3D parameters provide more data and fewer artifacts.
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Affiliation(s)
- Maria A. Guzman Aparicio
- Harvard Medical School
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA
| | - Teresa C. Chen
- Harvard Medical School
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA
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13
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Multimodal brain and retinal imaging of dopaminergic degeneration in Parkinson disease. Nat Rev Neurol 2022; 18:203-220. [PMID: 35177849 DOI: 10.1038/s41582-022-00618-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a progressive disorder characterized by dopaminergic neurodegeneration in the brain. The development of parkinsonism is preceded by a long prodromal phase, and >50% of dopaminergic neurons can be lost from the substantia nigra by the time of the initial diagnosis. Therefore, validation of in vivo imaging biomarkers for early diagnosis and monitoring of disease progression is essential for future therapeutic developments. PET and single-photon emission CT targeting the presynaptic terminals of dopaminergic neurons can be used for early diagnosis by detecting axonal degeneration in the striatum. However, these techniques poorly differentiate atypical parkinsonian syndromes from PD, and their availability is limited in clinical settings. Advanced MRI in which pathological changes in the substantia nigra are visualized with diffusion, iron-sensitive susceptibility and neuromelanin-sensitive sequences potentially represents a more accessible imaging tool. Although these techniques can visualize the classic degenerative changes in PD, they might be insufficient for phenotyping or prognostication of heterogeneous aspects of PD resulting from extranigral pathologies. The retina is an emerging imaging target owing to its pathological involvement early in PD, which correlates with brain pathology. Retinal optical coherence tomography (OCT) is a non-invasive technique to visualize structural changes in the retina. Progressive parafoveal thinning and fovea avascular zone remodelling, as revealed by OCT, provide potential biomarkers for early diagnosis and prognostication in PD. As we discuss in this Review, multimodal imaging of the substantia nigra and retina is a promising tool to aid diagnosis and management of PD.
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Kadomoto S, Muraoka Y, Uji A, Ooto S, Kawai K, Ishikura M, Nishigori N, Akagi T, Tsujikawa A. Human Foveal Cone and Müller Cells Examined by Adaptive Optics Optical Coherence Tomography. Transl Vis Sci Technol 2021; 10:17. [PMID: 34559184 PMCID: PMC8475288 DOI: 10.1167/tvst.10.11.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose The purpose of this study was to image and investigate the foveal microstructure of human cone and Müller cells using adaptive optics-optical coherence tomography. Methods Six healthy subjects underwent the prototype adaptive optics-optical coherence tomography imaging, which allowed an axial resolution of 3.4 µm and a transverse resolution of approximately 3 µm. The morphological features of the individual retinal cells observed in the foveola were qualitatively and quantitatively evaluated. Results In the six healthy subjects, the image B-scans showed hyper-reflective dots that were densely packed in the outer nuclear layer. The mean number, diameter, and density of hyper-reflective dots in the foveola were 250.8 ± 59.6, 12.7 ± 59.6 µm, and 6966 ± 1833/mm2, respectively. These qualitative and quantitative findings regarding the hyper-reflective dots were markedly consistent with the morphological features of the foveal cone cell nuclei. Additionally, the images showed the funnel-shaped hyporeflective bodies running vertically and obliquely between the inner and external limiting membranes, illustrating the cell morphology of the foveal Müller cells. Conclusions Using adaptive optics, we succeeded in visualizing cross-sectional images of the individual cone and Müller cells of the human retina in vivo. Translational Relevance Adaptive optics-optical coherence tomography would help to improve our understanding of the pathogenesis of macular diseases.
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Affiliation(s)
- Shin Kadomoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kentaro Kawai
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaharu Ishikura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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15
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Abstract
Early detection and monitoring are critical to the diagnosis and management of glaucoma, a progressive optic neuropathy that causes irreversible blindness. Optical coherence tomography (OCT) has become a commonly utilized imaging modality that aids in the detection and monitoring of structural glaucomatous damage. Since its inception in 1991, OCT has progressed through multiple iterations, from time-domain OCT, to spectral-domain OCT, to swept-source OCT, all of which have progressively improved the resolution and speed of scans. Even newer technological advancements and OCT applications, such as adaptive optics, visible-light OCT, and OCT-angiography, have enriched the use of OCT in the evaluation of glaucoma. This article reviews current commercial and state-of-the-art OCT technologies and analytic techniques in the context of their utility for glaucoma diagnosis and management, as well as promising future directions. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Alexi Geevarghese
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; .,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA.,Center for Neural Science, NYU College of Arts and Sciences, New York, NY 10003, USA
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; .,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; .,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA.,Center for Neural Science, NYU College of Arts and Sciences, New York, NY 10003, USA.,Department of Physiology and Neuroscience, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
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16
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Detecting retinal cell stress and apoptosis with DARC: Progression from lab to clinic. Prog Retin Eye Res 2021; 86:100976. [PMID: 34102318 DOI: 10.1016/j.preteyeres.2021.100976] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
DARC (Detection of Apoptosing Retinal Cells) is a retinal imaging technology that has been developed within the last 2 decades from basic laboratory science to Phase 2 clinical trials. It uses ANX776 (fluorescently labelled Annexin A5) to identify stressed and apoptotic cells in the living eye. During its development, DARC has undergone biochemistry optimisation, scale-up and GMP manufacture and extensive preclinical evaluation. Initially tested in preclinical glaucoma and optic neuropathy models, it has also been investigated in Alzheimer, Parkinson's and Diabetic models, and used to assess efficacy of therapies. Progression to clinical trials has not been speedy. Intravenous ANX776 has to date been found to be safe and well-tolerated in 129 patients, including 16 from Phase 1 and 113 from Phase 2. Results on glaucoma and AMD patients have been recently published, and suggest DARC with an AI-aided algorithm can be used to predict disease activity. New analyses of DARC in GA prediction are reported here. Although further studies are needed to validate these findings, it appears there is potential of the technology to be used as a biomarker. Much larger clinical studies will be needed before it can be considered as a diagnostic, although the relatively non-invasive nature of the nasal as opposed to intravenous administration would widen its acceptability in the future as a screening tool. This review describes DARC development and its progression into Phase 2 clinical trials from lab-based research. It discusses hypotheses, potential challenges, and regulatory hurdles in translating technology.
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17
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Konstantinou EK, Mendonça LSM, Braun P, Monahan KM, Mehta N, Gendelman I, Levine ES, Baumal CR, Witkin AJ, Duker JS, Waheed NK. Retinal Imaging Using a Confocal Scanning Laser Ophthalmoscope-Based High-Magnification Module. Ophthalmol Retina 2021; 5:438-449. [PMID: 32861857 DOI: 10.1016/j.oret.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate the usefulness of a high-magnification module (HMM) lens to visualize retinal photoreceptors, retinal nerve fiber layer (RNFL), and superficial retinal vasculature in physiologic and pathologic retinal conditions. DESIGN Observational descriptive study. PARTICIPANTS Thirty-two participants with normal and pathologic retina examination results. METHODS Normal and pathologic maculae were imaged in vivo using still and video HMM lens modes, with fixation and contrast adjustments to enhance visualization. The HMM images were classified qualitatively based on structures identified as either good (photoreceptors seen), average (photoreceptor mosaic cannot be visualized clearly, retinal vessels and other retinal changes can be seen), or poor (no identifiable structures). Selected eyes were imaged with fundus photography, OCT, OCT angiography, indocyanine green angiography, and fluorescein angiography for comparison with the pathologic maculae. MAIN OUTCOMES MEASURES Description of HMM module-obtained macula images. RESULTS From 32 eyes imaged (16 normal and 16 pathologic retinas), 12 of 16 normal and 11 of 16 pathologic retinas demonstrated at least average image quality, in which retinal vasculature and landmarks could be visualized. The mosaic pattern of hexagonal shapes representing photoreceptors could not be resolved in most pathologic retinas. For the retinas in which the photoreceptor mosaics were visualized (12 of 16 normal and 2 of 16 pathologic retinas), parafoveal mosaic patterns appeared denser with better image quality for all participants compared with foveal photoreceptors. Difficulty in resolving the photoreceptors in the umbo, fovea, and perifovea was encountered, similar to what has been reported with adaptive optics devices. The RNFL was seen as arcuate hyperreflective bundles. Flow was observed in the macular microvasculature. Poorly resolved photoreceptors and scattered hyperreflective foci were correlated with changes in the retinal pigment epithelium in eyes with age-related macular degeneration or central serous chorioretinopathy. Macular striae were seen in eyes with epiretinal membrane. CONCLUSIONS In most eyes, regardless of whether retinal pathologic features were present, it was challenging to obtain average quality (or better) images. In the few participants with good-quality imaging, the parafoveal photoreceptor mosaic, vascular flow, and various features of pathologic eyes could be visualized.
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Affiliation(s)
- Eleni K Konstantinou
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Luísa S M Mendonça
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Phillip Braun
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Yale University School of Medicine, New Haven, Connecticut
| | - Kyle M Monahan
- Data Lab, Tufts Technology Services, Tufts University, Medford, Massachusetts
| | - Nihaal Mehta
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Isaac Gendelman
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Emily S Levine
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Caroline R Baumal
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Andre J Witkin
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Jay S Duker
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.
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Ringel MJ, Tang EM, Tao YK. Advances in multimodal imaging in ophthalmology. Ther Adv Ophthalmol 2021; 13:25158414211002400. [PMID: 35187398 PMCID: PMC8855415 DOI: 10.1177/25158414211002400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Multimodality ophthalmic imaging systems aim to enhance the contrast, resolution, and functionality of existing technologies to improve disease diagnostics and therapeutic guidance. These systems include advanced acquisition and post-processing methods using optical coherence tomography (OCT), combined scanning laser ophthalmoscopy and OCT systems, adaptive optics, surgical guidance, and photoacoustic technologies. Here, we provide an overview of these ophthalmic imaging systems and their clinical and basic science applications.
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Affiliation(s)
- Morgan J. Ringel
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Eric M. Tang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Yuankai K. Tao
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
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19
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Kurokawa K, Crowell JA, Do N, Lee JJ, Miller DT. Multi-reference global registration of individual A-lines in adaptive optics optical coherence tomography retinal images. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200266R. [PMID: 33410310 PMCID: PMC7787477 DOI: 10.1117/1.jbo.26.1.016001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/10/2020] [Indexed: 05/18/2023]
Abstract
SIGNIFICANCE Adaptive optics optical coherence tomography (AO-OCT) technology enables non-invasive, high-resolution three-dimensional (3D) imaging of the retina and promises earlier detection of ocular disease. However, AO-OCT data are corrupted by eye-movement artifacts that must be removed in post-processing, a process rendered time-consuming by the immense quantity of data. AIM To efficiently remove eye-movement artifacts at the level of individual A-lines, including those present in any individual reference volume. APPROACH We developed a registration method that cascades (1) a 3D B-scan registration algorithm with (2) a global A-line registration algorithm for correcting torsional eye movements and image scaling and generating global motion-free coordinates. The first algorithm corrects 3D translational eye movements to a single reference volume, accelerated using parallel computing. The second algorithm combines outputs of multiple runs of the first algorithm using different reference volumes followed by an affine transformation, permitting registration of all images to a global coordinate system at the level of individual A-lines. RESULTS The 3D B-scan algorithm estimates and corrects 3D translational motions with high registration accuracy and robustness, even for volumes containing microsaccades. Averaging registered volumes improves our image quality metrics up to 22 dB. Implementation in CUDA™ on a graphics processing unit registers a 512 × 512 × 512 volume in only 10.6 s, 150 times faster than MATLAB™ on a central processing unit. The global A-line algorithm minimizes image distortion, improves regularity of the cone photoreceptor mosaic, and supports enhanced visualization of low-contrast retinal cellular features. Averaging registered volumes improves our image quality up to 9.4 dB. It also permits extending the imaging field of view (∼2.1 × ) and depth of focus (∼5.6 × ) beyond what is attainable with single-reference registration. CONCLUSIONS We can efficiently correct eye motion in all 3D at the level of individual A-lines using a global coordinate system.
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Affiliation(s)
- Kazuhiro Kurokawa
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - James A. Crowell
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - Nhan Do
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
- Google, Mountain View, California, United States
| | - John J. Lee
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
| | - Donald T. Miller
- Indiana University, School of Optometry, Bloomington, Indiana, United States
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20
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Akyol E, Hagag AM, Sivaprasad S, Lotery AJ. Adaptive optics: principles and applications in ophthalmology. Eye (Lond) 2021; 35:244-264. [PMID: 33257798 PMCID: PMC7852593 DOI: 10.1038/s41433-020-01286-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/19/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022] Open
Abstract
This is a comprehensive review of the principles and applications of adaptive optics (AO) in ophthalmology. It has been combined with flood illumination ophthalmoscopy, scanning laser ophthalmoscopy, as well as optical coherence tomography to image photoreceptors, retinal pigment epithelium (RPE), retinal ganglion cells, lamina cribrosa and the retinal vasculature. In this review, we highlight the clinical studies that have utilised AO to understand disease mechanisms. However, there are some limitations to using AO in a clinical setting including the cost of running an AO imaging service, the time needed to scan patients, the lack of normative databases and the very small size of area imaged. However, it is undoubtedly an exceptional research tool that enables visualisation of the retina at a cellular level.
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Affiliation(s)
- Engin Akyol
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ahmed M Hagag
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
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21
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Miller DA, Grannonico M, Liu M, Kuranov RV, Netland PA, Liu X, Zhang HF. Visible-Light Optical Coherence Tomography Fibergraphy for Quantitative Imaging of Retinal Ganglion Cell Axon Bundles. Transl Vis Sci Technol 2020; 9:11. [PMID: 33110707 PMCID: PMC7552935 DOI: 10.1167/tvst.9.11.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/18/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose To develop a practical technique for visualizing and quantifying retinal ganglion cell (RGC) axon bundles in vivo. Methods We applied visible-light optical coherence tomography (vis-OCT) to image the RGC axon bundles, referred to as vis-OCT fibergraphy, of healthy wild-type C57BL/6 mice. After vis-OCT imaging, retinas were flat-mounted, immunostained with anti-beta-III tubulin (Tuj1) antibody for RGC axons, and imaged with confocal microscopy. We quantitatively compared the RGC axon bundle networks imaged by in vivo vis-OCT and ex vivo confocal microscopy using semi-log Sholl analysis. Results Side-by-side comparison of ex vivo confocal microscopy and in vivo vis-OCT confirmed that vis-OCT fibergraphy captures true RGC axon bundle networks. The semi-log Sholl regression coefficients extracted from vis-OCT fibergrams (3.7 ± 0.8 mm–1) and confocal microscopy (3.6 ± 0.3 mm–1) images also showed good agreement with each other (n = 6). Conclusions We demonstrated the feasibility of using vis-OCT fibergraphy to visualize RGC axon bundles. Further applying Sholl analysis has the potential to identify biomarkers for non-invasively assessing RGC health. Translational Relevance Our novel technique for visualizing and quantifying RGC axon bundles in vivo provides a potential measurement tool for diagnosing and tracking the progression of optic neuropathies.
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Affiliation(s)
- David A Miller
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Marta Grannonico
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Mingna Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Roman V Kuranov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Opticent Health, Evanston, IL, USA
| | - Peter A Netland
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Xiaorong Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA.,Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Hao F Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Ophthalmology, Northwestern University, Evanston, IL, USA
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22
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Lee EJ, Kee HJ, Han JC, Kee C. Evidence-based understanding of disc hemorrhage in glaucoma. Surv Ophthalmol 2020; 66:412-422. [PMID: 32949554 DOI: 10.1016/j.survophthal.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
Disc hemorrhage is a characteristic finding that is highly associated with glaucoma development or progression. Consequently, the literature commonly designates disc hemorrhage as a "risk factor" for glaucoma progression; however, the exact cause-and-effect relationship or mechanism remains unclear. In this review, we discuss the emerging evidence that disc hemorrhage is a secondary development that follows glaucomatous damage. As our understanding of disc hemorrhage has progressed in recent decades, we suggest the terminology be changed from "risk factor" to "indicator" of ongoing glaucomatous development or progression for a more accurate description, better indication of the clinical implications and, ultimately, a better guide for future research.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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23
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Miller DT, Kurokawa K. Cellular-Scale Imaging of Transparent Retinal Structures and Processes Using Adaptive Optics Optical Coherence Tomography. Annu Rev Vis Sci 2020; 6:115-148. [PMID: 32609578 PMCID: PMC7864592 DOI: 10.1146/annurev-vision-030320-041255] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High-resolution retinal imaging is revolutionizing how scientists and clinicians study the retina on the cellular scale. Its exquisite sensitivity enables time-lapse optical biopsies that capture minute changes in the structure and physiological processes of cells in the living eye. This information is increasingly used to detect disease onset and monitor disease progression during early stages, raising the possibility of personalized eye care. Powerful high-resolution imaging tools have been in development for more than two decades; one that has garnered considerable interest in recent years is optical coherence tomography enhanced with adaptive optics. State-of-the-art adaptive optics optical coherence tomography (AO-OCT) makes it possible to visualize even highly transparent cells and measure some of their internal processes at all depths within the retina, permitting reconstruction of a 3D view of the living microscopic retina. In this review, we report current AO-OCT performance and its success in visualizing and quantifying these once-invisible cells in human eyes.
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Affiliation(s)
- Donald T Miller
- School of Optometry, Indiana University, Bloomington, Indiana 47405, USA; ,
| | - Kazuhiro Kurokawa
- School of Optometry, Indiana University, Bloomington, Indiana 47405, USA; ,
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24
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Girard MJA, Schmetterer L. Artificial intelligence and deep learning in glaucoma: Current state and future prospects. PROGRESS IN BRAIN RESEARCH 2020; 257:37-64. [PMID: 32988472 DOI: 10.1016/bs.pbr.2020.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past few years, there has been an unprecedented and tremendous excitement for artificial intelligence (AI) research in the field of Ophthalmology; this has naturally been translated to glaucoma-a progressive optic neuropathy characterized by retinal ganglion cell axon loss and associated visual field defects. In this review, we aim to discuss how AI may have a unique opportunity to tackle the many challenges faced in the glaucoma clinic. This is because glaucoma remains poorly understood with difficulties in providing early diagnosis and prognosis accurately and in a timely fashion. In the short term, AI could also become a game changer by paving the way for the first cost-effective glaucoma screening campaigns. While there are undeniable technical and clinical challenges ahead, and more so than for other ophthalmic disorders whereby AI is already booming, we strongly believe that glaucoma specialists should embrace AI as a companion to their practice. Finally, this review will also remind ourselves that glaucoma is a complex group of disorders with a multitude of physiological manifestations that cannot yet be observed clinically. AI in glaucoma is here to stay, but it will not be the only tool to solve glaucoma.
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Affiliation(s)
- Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
| | - Leopold Schmetterer
- Ocular Imaging, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland.
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25
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Beykin G, Norcia AM, Srinivasan VJ, Dubra A, Goldberg JL. Discovery and clinical translation of novel glaucoma biomarkers. Prog Retin Eye Res 2020; 80:100875. [PMID: 32659431 DOI: 10.1016/j.preteyeres.2020.100875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
Glaucoma and other optic neuropathies are characterized by progressive dysfunction and loss of retinal ganglion cells and their axons. Given the high prevalence of glaucoma-related blindness and the availability of treatment options, improving the diagnosis and precise monitoring of progression in these conditions is paramount. Here we review recent progress in the development of novel biomarkers for glaucoma in the context of disease pathophysiology and we propose future steps for the field, including integration of exploratory biomarker outcomes into prospective therapeutic trials. We anticipate that, when validated, some of the novel glaucoma biomarkers discussed here will prove useful for clinical diagnosis and prediction of progression, as well as monitoring of clinical responses to standard and investigational therapies.
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Affiliation(s)
- Gala Beykin
- Spencer Center for Vision Research at Stanford University, 2370 Watson Ct, Palo Alto, CA, 94303, USA.
| | - Anthony M Norcia
- Department of Psychology, Stanford University, 290 Jane Stanford Way, Stanford, CA, 94305, USA.
| | - Vivek J Srinivasan
- Department of Biomedical Engineering, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA; Department of Ophthalmology and Vision Science, University of California Davis School of Medicine, 4610 X St, Sacramento, CA, 96817, USA.
| | - Alfredo Dubra
- Spencer Center for Vision Research at Stanford University, 2370 Watson Ct, Palo Alto, CA, 94303, USA.
| | - Jeffrey L Goldberg
- Spencer Center for Vision Research at Stanford University, 2370 Watson Ct, Palo Alto, CA, 94303, USA.
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26
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Maddipatla R, Cervantes J, Otani Y, Cense B. Retinal imaging with optical coherence tomography and low-loss adaptive optics using a 2.8-mm beam size. JOURNAL OF BIOPHOTONICS 2019; 12:e201800192. [PMID: 30328279 DOI: 10.1002/jbio.201800192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/24/2018] [Accepted: 10/11/2018] [Indexed: 05/02/2023]
Abstract
As data acquisition for retinal imaging with optical coherence tomography (OCT) becomes faster, efficient collection of photons becomes more important to maintain image quality. One approach is to use a larger aperture at the eye's pupil to collect more photons that have been reflected from the retina. A 2.8-mm beam diameter system with only seven reflecting surfaces was developed for low-loss retinal imaging. The larger beam size requires defocus and astigmatism correction, which was done in a closed loop adaptive optics method using a Shack-Hartmann wavefront sensor and a deformable mirror (DM) with 140 actuators and a ±2.75 μm stroke. This DM facilitates defocus correction ranging from approximately -3 D to +3 D. Comparing the new system with a standard 1.2-mm system on a model eye, a signal-to-noise gain of 4.5 dB and a 2.3 times smaller speckle size were measured. Measurements on the retinas of five subjects showed even better results, with increases in dynamic range up to 13 dB. Note that the new sample arm only occupies 30 cm × 60 cm, which makes it highly suitable for imaging in a clinical environment. Figure: B-scan images obtained over a width of 8 deg from the right eye of a 31-year-old Caucasian male. While the left side was imaged with a standard 1.2-mm OCT system, the right side was imaged with the 2.8-mm system. Both images were collected with the same integration time and incident power, after correction of aberrations. Using the dynamic range within the images, which is determined by comparing the highest pixel value to the noise floor, a difference in dynamic range of 10.8 dB was measured between the two systems.
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Affiliation(s)
- Reddikumar Maddipatla
- Center for Optical Research and Education, Utsunomiya University, Utsunomiya, Japan
- School of Optometry, Indiana University, Bloomington, Indiana
| | - Joel Cervantes
- Center for Optical Research and Education, Utsunomiya University, Utsunomiya, Japan
- Centro Universitario de Ciencias Exactas e Ingenierías (CUCEI), Universidad de Guadalajara, Guadalajara, Jal, Mexico
| | - Yukitoshi Otani
- Center for Optical Research and Education, Utsunomiya University, Utsunomiya, Japan
- Department of Optical Engineering, Utsunomiya University, Tochigi, Japan
| | - Barry Cense
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, University of Western Australia, Crawley, Western Australia, Australia
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Shu X, Beckmann L, Wang Y, Rubinoff I, Lucy K, Ishikawa H, Wollstein G, Fawzi AA, Schuman JS, Kuranov RV, Zhang HF. Designing visible-light optical coherence tomography towards clinics. Quant Imaging Med Surg 2019; 9:769-781. [PMID: 31281773 DOI: 10.21037/qims.2019.05.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The capabilities of visible-light optical coherence tomography (vis-OCT) in noninvasive anatomical and functional retinal imaging have been demonstrated by multiple groups in both rodents and healthy human subjects. Translating laboratory prototypes to an integrated clinical-environment-friendly system is required to explore the full potential of vis-OCT in disease management. Methods We developed and optimized a portable vis-OCT system for human retinal imaging in clinical settings. We acquired raster- and circular-scan images from both healthy and diseased human eyes. Results The new vis-OCT provided high-quality retinal images of both subjects without any known eye diseases and patients with various retinal diseases, including retinal occlusive disease and diabetic retinopathy (DR) over a broad range of ages. Conclusions A newly designed vis-OCT system is sufficiently optimized to be suited for routine patients' examinations in clinics. Vis-OCT has the potential to add new anatomical and functional imaging capabilities to ophthalmic clinical care.
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Affiliation(s)
- Xiao Shu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Lisa Beckmann
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Ian Rubinoff
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Katie Lucy
- NYU Langone Eye Center, NYU School of Medicine, New York, NY, USA
| | - Hiroshi Ishikawa
- NYU Langone Eye Center, NYU School of Medicine, New York, NY, USA
| | - Gadi Wollstein
- NYU Langone Eye Center, NYU School of Medicine, New York, NY, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Joel S Schuman
- NYU Langone Eye Center, NYU School of Medicine, New York, NY, USA
| | - Roman V Kuranov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Opticent Health, Evanston, IL, USA
| | - Hao F Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Ophthalmology, Northwestern University, Chicago, IL, USA
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Tran H, Wallace J, Zhu Z, Lucy KA, Voorhees AP, Schmitt SE, Bilonick RA, Schuman JS, Smith MA, Wollstein G, Sigal IA. Seeing the Hidden Lamina: Effects of Exsanguination on the Optic Nerve Head. Invest Ophthalmol Vis Sci 2019; 59:2564-2575. [PMID: 29847664 PMCID: PMC5968837 DOI: 10.1167/iovs.17-23356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To introduce an experimental approach for direct comparison of the primate optic nerve head (ONH) before and after death by exsanguination. Method The ONHs of four eyes from three monkeys were imaged with spectral-domain optical coherence tomography (OCT) before and after exsanguination under controlled IOP. ONH structures, including the Bruch membrane (BM), BM opening, inner limiting membrane (ILM), and anterior lamina cribrosa (ALC) were delineated on 18 virtual radial sections per OCT scan. Thirteen parameters were analyzed: scleral canal at BM opening (area, planarity, and aspect ratio), ILM depth, BM depth; ALC (depth, shape index, and curvedness), and ALC visibility (globally, superior, inferior, nasal, and temporal quadrants). Results All four ALC quadrants had a statistically significant improvement in visibility after exsanguination (overall P < 0.001). ALC visibility increased by 35% globally and by 36%, 37%, 14%, and 4% in the superior, inferior, nasal, and temporal quadrants, respectively. ALC increased 4.1%, 1.9%, and 0.1% in curvedness, shape index, and depth, respectively. Scleral canals increased 7.2%, 25.2%, and 1.1% in area, planarity, and aspect ratio, respectively. ILM and BM depths averaged -7.5% and -55.2% decreases in depth, respectively. Most, but not all, changes were beyond the repeatability range. Conclusions Exsanguination allows for improved lamina characterization, especially in regions typically blocked by shadowing in OCT. The results also demonstrate changes in ONH morphology due to the loss of blood pressure. Future research will be needed to determine whether there are differences in ONH biomechanics before and after exsanguination and what those differences would imply.
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Affiliation(s)
- Huong Tran
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jacob Wallace
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ziyi Zhu
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Katie A Lucy
- New York University Langone Eye Center, NYU School of Medicine, New York, New York, United States
| | - Andrew P Voorhees
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Samantha E Schmitt
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Richard A Bilonick
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Joel S Schuman
- New York University Langone Eye Center, NYU School of Medicine, New York, New York, United States
| | - Matthew A Smith
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Gadi Wollstein
- New York University Langone Eye Center, NYU School of Medicine, New York, New York, United States
| | - Ian A Sigal
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Burns SA, Elsner AE, Sapoznik KA, Warner RL, Gast TJ. Adaptive optics imaging of the human retina. Prog Retin Eye Res 2019; 68:1-30. [PMID: 30165239 PMCID: PMC6347528 DOI: 10.1016/j.preteyeres.2018.08.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/18/2022]
Abstract
Adaptive Optics (AO) retinal imaging has provided revolutionary tools to scientists and clinicians for studying retinal structure and function in the living eye. From animal models to clinical patients, AO imaging is changing the way scientists are approaching the study of the retina. By providing cellular and subcellular details without the need for histology, it is now possible to perform large scale studies as well as to understand how an individual retina changes over time. Because AO retinal imaging is non-invasive and when performed with near-IR wavelengths both safe and easily tolerated by patients, it holds promise for being incorporated into clinical trials providing cell specific approaches to monitoring diseases and therapeutic interventions. AO is being used to enhance the ability of OCT, fluorescence imaging, and reflectance imaging. By incorporating imaging that is sensitive to differences in the scattering properties of retinal tissue, it is especially sensitive to disease, which can drastically impact retinal tissue properties. This review examines human AO retinal imaging with a concentration on the use of the Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO). It first covers the background and the overall approaches to human AO retinal imaging, and the technology involved, and then concentrates on using AO retinal imaging to study the structure and function of the retina.
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Affiliation(s)
- Stephen A Burns
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States.
| | - Ann E Elsner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Kaitlyn A Sapoznik
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Raymond L Warner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Thomas J Gast
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
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Unterlauft JD, Rehak M, Böhm MRR, Rauscher FG. Analyzing the impact of glaucoma on the macular architecture using spectral-domain optical coherence tomography. PLoS One 2018; 13:e0209610. [PMID: 30596720 PMCID: PMC6312265 DOI: 10.1371/journal.pone.0209610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/07/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose Using spectral domain optical coherence tomography (SD-OCT) the retina can be segmented automatically to visualize all retinal layers. In glaucoma chronically elevated intraocular pressure leads to a decline of retinal ganglion cells (RGC) which changes retinal architecture. The goal of these analyses was to gain insight into the changes induced by glaucoma within all macular layers using SD-OCT within a closely circumscribed glaucoma cohort. Materials and methods SD-OCT measurements with automated retinal layer segmentation were performed in both eyes of primary open-angle glaucoma patients with a defined monocular absolute visual field scotoma in the central 10° of the visual field and in an age-matched healthy control group. Thickness of single retinal layers and entire retina were compared with special attention to the localization of the visual field scotoma in the glaucomatous eyes. Results 30 eyes of 15 glaucoma patients and 15 eyes of 15 healthy controls were included in this study. Statistical significant thickness differences were detected in the control group between superior and inferior retina for the retinal nerve fiber layer (RNFL), the outer plexiform layer (OPL) and the outer nuclear layer (ONL). In the glaucoma group thickness differences between worse and less affected eyes in the RNFL, the ganglion cell layer (GCL) and the inner plexiform layers (INL) were found. Comparison between healthy and diseased eyes revealed significant thickness differences in the RNFL, GCL, IPL and total retinal thickness but not the outer retinal layers. Conclusion Comparison between SD-OCT measurements of the macula between healthy and glaucomatous eyes in a closely circumscribed disease stage showed a pronounced disease impact on the inner but not the outer retina. These results provide evidence that GCL and IPL thickness seem to be good measures to discriminate between affected and unaffected eyes in testing for glaucoma.
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Affiliation(s)
- Jan D. Unterlauft
- Department of Ophthalmology, Leipzig University Hospital, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, Leipzig University Hospital, Leipzig, Germany
| | - Michael R. R. Böhm
- Department of Ophthalmology, University Hospital Essen, University of Duisburg/Essen, Essen, Germany
| | - Franziska G. Rauscher
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
- * E-mail:
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31
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Affiliation(s)
- Timothy E. Yap
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Eduardo M. Normando
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
| | - Maria Francesca Cordeiro
- Imperial College Healthcare NHS Trust (ICHNT), The Western Eye Hospital, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Department of Visual Neuroscience, Glaucoma and Retinal Neurodegeneration Group, UCL Institute of Ophthalmology, London, UK
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32
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Popa-Cherechenau A, Schmidl D, Garhöfer G, Schmetterer L. [Structural endpoints for glaucoma studies]. Ophthalmologe 2018; 116:5-13. [PMID: 29511811 DOI: 10.1007/s00347-018-0670-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Structural endpoints have been discussed as surrogate endpoints for the approval of neuroprotective drugs in glaucoma. OBJECTIVE Is the evidence strong enough to establish structural endpoints as surrogate endpoints? MATERIAL AND METHODS Review of current understanding between structure and function in glaucoma. RESULTS The introduction of optical coherence tomography has revolutionized imaging in glaucoma patients. Clinically either the nerve fiber layer thickness can be measured along a circle centered in the optic nerve head or the ganglion cell layer thickness can be assessed in the macular region, the latter being quantified in combination with other inner retinal layers. On a microscopic level there is a strong correlation between structural and functional loss but this relation can only partially be described with currently available clinical methods. This is particularly true for longitudinal course of the disease in glaucoma patients. Novel imaging techniques that are not yet used clinically may have the potential to increase our understanding between structure and function in glaucoma but further research in this field is required. CONCLUSION The current evidence does not allow the establishment of structural endpoints as surrogate endpoints for phase 3 studies in glaucoma. Neuroprotective drugs have to be approved on the basis of visual field data because this is the patient-relevant endpoint. Structural endpoints can, however, play an important role in phase 2 and proof of concept studies.
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Affiliation(s)
- A Popa-Cherechenau
- Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Österreich.,Medizinische und Pharmazeutische Universität Carol Davila, Bukarest, Rumänien.,Abteilung für Ophthalmologie, Notfallzentrum der Universitätsklinik Bukarest, Bukarest, Rumänien
| | - D Schmidl
- Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Österreich
| | - G Garhöfer
- Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Österreich
| | - L Schmetterer
- Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Österreich. .,Singapore Eye Research Institute, SERI (Augenforschungszentrum Singapur), College Str. 20, Discovery Tower Ebene 6, 169856, Singapur, Singapur. .,Lee Kong Chian Medical Schools, Nanyang Technological University (NTU), Singapur, Singapur. .,Klinisches Fortbildungszentrum Ophthalmologie und Visual Sciences, Duke-NUS Medical School, Singapur, Singapur. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapur, Singapur.
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Shu X, Beckmann L, Zhang HF. Visible-light optical coherence tomography: a review. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-14. [PMID: 29218923 PMCID: PMC5745673 DOI: 10.1117/1.jbo.22.12.121707] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/13/2017] [Indexed: 05/03/2023]
Abstract
Visible-light optical coherence tomography (vis-OCT) is an emerging imaging modality, providing new capabilities in both anatomical and functional imaging of biological tissue. It relies on visible light illumination, whereas most commercial and investigational OCTs use near-infrared light. As a result, vis-OCT requires different considerations in engineering design and implementation but brings unique potential benefits to both fundamental research and clinical care of several diseases. Here, we intend to provide a summary of the development of vis-OCT and its demonstrated applications. We also provide perspectives on future technology improvement and applications.
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Affiliation(s)
- Xiao Shu
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois, United States
| | - Lisa Beckmann
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois, United States
| | - Hao F. Zhang
- Northwestern University, Department of Biomedical Engineering, Evanston, Illinois, United States
- Northwestern University, Department of Ophthalmology, Chicago, Illinois, United States
- Address all correspondence to: Hao F. Zhang, E-mail:
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Lavinsky F, Wollstein G, Tauber J, Schuman JS. The Future of Imaging in Detecting Glaucoma Progression. Ophthalmology 2017; 124:S76-S82. [PMID: 29157365 DOI: 10.1016/j.ophtha.2017.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/11/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
Abstract
Ocular imaging has been heavily incorporated into glaucoma management and provides important information that aids in the detection of disease progression. Longitudinal studies have shown that the circumpapillary retinal nerve fiber layer is an important parameter for glaucoma progression detection, whereas other studies have demonstrated that macular parameters, such as the ganglion cell inner plexiform layer and optic nerve head parameters, also are useful for progression detection. The introduction of novel technologies with faster scan speeds, wider scanning fields, higher resolution, and improved tissue penetration has enabled the precise quantification of additional key ocular structures, such as the individual retinal layers, optic nerve head, choroid, and lamina cribrosa. Furthermore, extracting functional information from scans such as blood flow rate and oxygen consumption provides new perspectives on the disease and its progression. These novel methods promise improved detection of glaucoma progression and better insight into the mechanisms of progression that will lead to better targeted treatment options to prevent visual damage and blindness.
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Affiliation(s)
- Fabio Lavinsky
- NYU Langone Eye Center, New York University School of Medicine, New York, New York
| | - Gadi Wollstein
- NYU Langone Eye Center, New York University School of Medicine, New York, New York
| | - Jenna Tauber
- NYU Langone Eye Center, New York University School of Medicine, New York, New York
| | - Joel S Schuman
- NYU Langone Eye Center, New York University School of Medicine, New York, New York.
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Ju MJ, Heisler M, Wahl D, Jian Y, Sarunic MV. Multiscale sensorless adaptive optics OCT angiography system for in vivo human retinal imaging. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-10. [PMID: 29094524 DOI: 10.1117/1.jbo.22.12.121703] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/05/2017] [Indexed: 05/25/2023]
Abstract
We present a multiscale sensorless adaptive optics (SAO) OCT system capable of imaging retinal structure and vasculature with various fields-of-view (FOV) and resolutions. Using a single deformable mirror and exploiting the polarization properties of light, the SAO-OCT-A was implemented in a compact and easy to operate system. With the ability to adjust the beam diameter at the pupil, retinal imaging was demonstrated at two different numerical apertures with the same system. The general morphological structure and retinal vasculature could be observed with a few tens of micrometer-scale lateral resolution with conventional OCT and OCT-A scanning protocols with a 1.7-mm-diameter beam incident at the pupil and a large FOV (15 deg× 15 deg). Changing the system to a higher numerical aperture with a 5.0-mm-diameter beam incident at the pupil and the SAO aberration correction, the FOV was reduced to 3 deg× 3 deg for fine detailed imaging of morphological structure and microvasculature such as the photoreceptor mosaic and capillaries. Multiscale functional SAO-OCT imaging was performed on four healthy subjects, demonstrating its functionality and potential for clinical utility.
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Affiliation(s)
- Myeong Jin Ju
- Simon Fraser University, Department of Engineering Science, Burnaby, British Columbia, Canada
| | - Morgan Heisler
- Simon Fraser University, Department of Engineering Science, Burnaby, British Columbia, Canada
| | - Daniel Wahl
- Simon Fraser University, Department of Engineering Science, Burnaby, British Columbia, Canada
| | - Yifan Jian
- Simon Fraser University, Department of Engineering Science, Burnaby, British Columbia, Canada
| | - Marinko V Sarunic
- Simon Fraser University, Department of Engineering Science, Burnaby, British Columbia, Canada
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Lee EJ, Han JC, Kee C. A novel hypothesis for the pathogenesis of glaucomatous disc hemorrhage. Prog Retin Eye Res 2017; 60:20-43. [DOI: 10.1016/j.preteyeres.2017.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 01/16/2023]
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Pircher M, Zawadzki RJ. Review of adaptive optics OCT (AO-OCT): principles and applications for retinal imaging [Invited]. BIOMEDICAL OPTICS EXPRESS 2017; 8:2536-2562. [PMID: 28663890 PMCID: PMC5480497 DOI: 10.1364/boe.8.002536] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/08/2017] [Accepted: 04/09/2017] [Indexed: 05/17/2023]
Abstract
In vivo imaging of the human retina with a resolution that allows visualization of cellular structures has proven to be essential to broaden our knowledge about the physiology of this precious and very complex neural tissue that enables the first steps in vision. Many pathologic changes originate from functional and structural alterations on a cellular scale, long before any degradation in vision can be noted. Therefore, it is important to investigate these tissues with a sufficient level of detail in order to better understand associated disease development or the effects of therapeutic intervention. Optical retinal imaging modalities rely on the optical elements of the eye itself (mainly the cornea and lens) to produce retinal images and are therefore affected by the specific arrangement of these elements and possible imperfections in curvature. Thus, aberrations are introduced to the imaging light and image quality is degraded. To compensate for these aberrations, adaptive optics (AO), a technology initially developed in astronomy, has been utilized. However, the axial sectioning provided by retinal AO-based fundus cameras and scanning laser ophthalmoscope instruments is limited to tens of micrometers because of the rather small available numerical aperture of the eye. To overcome this limitation and thus achieve much higher axial sectioning in the order of 2-5µm, AO has been combined with optical coherence tomography (OCT) into AO-OCT. This enabled for the first time in vivo volumetric retinal imaging with high isotropic resolution. This article summarizes the technical aspects of AO-OCT and provides an overview on its various implementations and some of its clinical applications. In addition, latest developments in the field, such as computational AO-OCT and wavefront sensor less AO-OCT, are covered.
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Affiliation(s)
- Michael Pircher
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Währinger Gürtel 18-20/4L, 1090 Vienna, Austria
| | - Robert J Zawadzki
- UC Davis RISE Eye-Pod Laboratory, Dept. of Cell Biology and Human Anatomy, University of California Davis, 4320 Tupper Hall, Davis, CA 95616, USA
- Vision Science and Advanced Retinal Imaging Laboratory (VSRI) and Department of Ophthalmology and Vision Science, UC Davis, 4860 Y Street, Ste. 2400, Sacramento, CA 95817, USA
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